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We sit down with medical student Medha Venigalla to explore the urgent issue of resident sleep deprivation and its impact on health care. We discuss the systemic challenges residents face, including long hours, under-reporting of work, and the culture of overwork. Medha shares insights on how sleep loss not only affects residents’ health but also patient safety, leading to increased medical errors and burnout. We also examine potential policy changes and cultural shifts needed to protect residents and improve care quality.
Medha Venigalla is a medical student.
She discusses the KevinMD article, “The cost of exhaustion: Resident fatigue is a public health emergency.”
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Transcript
Kevin Pho: Hi, and welcome to the show. Subscribe at KevinMD.com/podcast. Today we welcome Medha Venigalla. She’s a second-year medical student. Today’s KevinMD article is “The cost of exhaustion: Resident fatigue is a public health emergency.” Medha, welcome to the show.
Medha Venigalla: Thank you so much for having me. Happy to be here.
Kevin Pho: All right, so let’s start by jumping into your article, “The cost of exhaustion: Resident fatigue is a public health emergency.” Before talking about the article itself, what led you to this one in the first place?
Medha Venigalla: Yeah, so I wrote this article during my first year in med school. I had heard everyone talk about how med school is hard, and I expected that, but going in, it was definitely an adjustment to fix my study schedule and fix how my day was going to look, and it definitely required time management. Within that, I started dealing with sleep trouble. Meeting residents, meeting older med students, and meeting clinicians, I learned that sleep deprivation is a problem in the field.
We had an assignment last year in our health policy class, and they wanted us to write an op-ed about an issue that was important to us, that we thought we should draw attention to. So I chose resident sleep deprivation as the issue I wanted to write about. Sleep is really important to me, and I think it’s important to everyone, considering we spend a third of our lives asleep.
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Kevin Pho: So when you were a first-year medical student, you said that you talked to a lot of the interns and residents, and even senior medical students. Tell us, what did you hear from them, especially regarding sleep?
Medha Venigalla: Yeah, I heard that, obviously, everyone loves what they do here. Everyone is really excited to be here, and it’s definitely a privilege to get to do what medical professionals get to do. But at the same time, it is important to see yourself as a person. I know that a lot of the residents I talked to were talking about long hours and how it was stressful and taking a toll on their health at times, a toll on their personal health or their personal wellness and their personal relationships. So I think that felt like a cause of concern to me, and to them as well.
Recently, the residents at UChicago actually unionized, calling for better conditions and better hours. So that was something that definitely is an issue that people are thinking about here at UChicago, and people are taking action, so I wanted to be a part of that.
Kevin Pho: All right, so tell us about your op-ed for those who didn’t get a chance to read it.
Medha Venigalla: Yeah, so my op-ed is called “The cost of exhaustion: Resident fatigue is a public health emergency.” In that article, I talk about how resident fatigue negatively affects not only the health of our residents but also the health of patients and others that residents may interact with while they’re in a state of cognitive impairment due to their lack of sleep.
I found a lot of interesting things out while I was researching this article. Resident fatigue can cause increased motor vehicle accidents, so that’s definitely a danger to others other than the residents themselves, as well as the cognitive impairment that they experience after shifts that are twenty-four hours long or so. It’s equivalent to being legally drunk. So that’s definitely a concern when they’re treating patients and have their health in their hands, and definitely something that I wanted to draw attention to.
Recently, duty-hour limits have been imposed by the ACGME. They cap the work week at eighty hours and shifts at twenty-four hours. But at the end of the day, it’s a regulation, but it has to be enforced. There’s a lot of underreporting of hours. The culture in medicine is to go, go, go, and to perform to impress, and that might push people to underreport hours or not be completely honest about being overworked. Reputation matters in this field, and that means that mental health may be put on the back burner a little bit for trainees in this field. So definitely, that’s something that we need to take action about collectively as a field.
Kevin Pho: Now, when you said that you heard that residents sometimes underreported the hours that they work because of the culture of medicine, do you have any personal stories (of course, you could just say anonymously) where residents specifically said that they worked more hours than they actually reported?
Medha Venigalla: I personally haven’t met anyone who has done that or has told me that they’ve done that. I would say the culture here at UChicago is honestly better than I would have expected, hearing all these stories about residency. And again, the residents unionized, as I said, so mental health and wellness, resident wellness, resident fatigue, is definitely something that’s coming to the forefront here at UChicago. But I have read stories online, and statistics, about people who have done that out of concern.
Kevin Pho: In terms of the cognitive impairment of fatigue, is there a direct link between cognitive impairment and increased medical errors that you found during your research?
Medha Venigalla: Yes, there is. That is another thing I talk about in my article. Residents who worked longer shifts had a higher incidence of medical errors. It’s pretty cut and dried: If you sleep less, you’re cognitively impaired, and you are at risk of making more mistakes. Another study also found that more of these mistakes led to fatal outcomes for patients for residents who are on longer shifts.
Kevin Pho: So in terms of the ACGME limiting work hours to eighty hours a week and shifts no longer than twenty-four hours, what more can we do from a regulatory standpoint?
Medha Venigalla: Yeah, there’s actually an act in Congress right now, the Resident Physician Shortage Act, I believe. This act is actually looking to increase the number of residency spots in the United States, one, to address physician shortage issues, and two, cut back on the hours that our residents work today. So that’s definitely something that’s on the table. I think that capping the hours did go a long way, but I think that there’s more to be done in terms of enforcement within these programs. So that’s definitely something to look at in the coming future.
Kevin Pho: And it’s been a while since I’ve been in an academic medical environment. So when hours were capped, some of the criticisms that I read on KevinMD is that it transforms the mentality the physician has to a patient to more of a shift-work mentality, right? Because after a certain number of hours, they have to pass on care of that patient to the next physician. So what do you think about that? Because traditionally, the older attendings would stay with a patient as long as they could to really develop that relationship, but now with caps on hours, you can’t do that as often anymore. So as a second-year medical student, what are your thoughts on that?
Medha Venigalla: So I think that definitely, while it may seem like a shift-work mentality, I think that at the end of the day, residents will take their patients’ health into their own hands and take responsibility, and I think that means that they will follow their patients for as long as necessary before switching them off.
Kevin Pho: So you mentioned that the residents at the University of Chicago have formed a union to push back about some of these issues concerning resident fatigue. Tell us more about that initiative.
Medha Venigalla: Yeah, so this actually happened, I think, earlier this year, that they unionized. Pay was definitely a concern, and hours were a concern. At the same time, we do need to recognize that these are medical residents. Long hours are necessary. There is a lot of training and work to be done, a lot to learn before a resident becomes an attending. So at the same time, I understand that, and all the residents who came to talk to us about the unionization initiative understood that as well. But at the end of the day, they wanted to have better working conditions so that they, as physicians, can perform better in the workplace, perform better for their patients, and have better outcomes as a whole for the institution.
So yeah, it was definitely something that a lot of residents supported. A lot of the medical students also supported this effort. So I think it was definitely a good thing that happened, that had a lot of support behind it.
Kevin Pho: Yeah, so tell us about some of the discussions that you had as a medical student when you heard that the residents were unionizing. I know it’s going to be a couple years before you’re a resident, but among the medical school class, what were your thoughts when you heard this news that the residents were unionizing?
Medha Venigalla: Yeah, I think a lot of us were surprised. I was, but also, at the same time, optimistic and happy to hear that resident wellness is coming to the forefront. In terms of lifestyle as a resident, wellness is becoming something that is more and more important, and I think that speaks a lot for the field in general. I’m glad to see that mental health and wellness are coming to the forefront in the field as a whole, because, again, like I said, I think that means well for the patients that we see. And for us as medical students, to know that this is the future that current residents, current physicians, are creating for us, I think that makes us feel very supported and optimistic for the future, more excited to do the work that we’re going to do in the future.
Kevin Pho: So one of the things I hear is that burnout sometimes even starts in medical school, and I know that there have been some initiatives to try to reduce that and take some of the pressure off. I know that some medical schools have courses that are pass/fail. I know Step 1 is now pass/fail. So from a medical student standpoint, are you seeing some initiatives to try to reduce the potential burnout that you’re seeing among your peers?
Medha Venigalla: Yeah, I definitely think so. I agree, pass/fail is something that’s becoming widespread across the United States for preclinical courses. And I definitely think that at the end of the day, the people that are admitted into medical school are hard workers. They have work ethic. They have discipline. And they’re people that will not take that lightly. I think even though courses are pass/fail, there is still a standard expected of us, and everyone will meet that standard because they’ve made it this far. They’ve shown their passion for the field. So I definitely think that, on the medical schools’ part, that is a great initiative that I think is doing a lot of good for mental health within trainees and within the field in general.
Kevin Pho: So tell us what more could be done. I know that you’re not a resident yet, but even from a medical student perspective, anything more that could be done to reduce the potential burnout among medical students and residents, what would you do?
Medha Venigalla: Yeah, I think definitely, in terms of residents, hours is probably my number one thing that I would want to change about being a resident. But in terms of medical school, I think they’ve come a long way, like you said, like the pass/fail Step 1 and the pass/fail for preclinical, maintaining standards while at the same time considering the mental health of medical trainees.
Another thing that I’ve heard, it’s becoming more of a discussion, is during the rotation year. I know that a lot of schools do still have grading for the rotation year, and it’s very interesting to learn on the wards, and you learn so much more, maybe more so than you do in any other year of medical school. But at the same time, stresses are high for students that are on the wards, because grading can be subjective. It can be hard to know what’s expected of you when you’re with different attendings. So I think that that is definitely a point of contention among medical students that could be addressed, like maybe some more objectivity for grading during the rotation year. And even though that’s just one year of medical school, I know that that is a source of stress for clinical and preclinical medical students alike.
Kevin Pho: When you mention hours as part of the solution that you would further do, are you talking about the enforcement of the eighty hours per week, or are you talking about further reducing the hours that residents are allowed to work?
Medha Venigalla: I think enforcement would be a great place to start, because at the end of the day, there are regulations that exist at the current time. But although they are enforced in a lot of places, there are places where residents may slip through the cracks. And of course, mental health is still an issue in the field, even with these regulations in place. Resident suicides are still happening. Will West is a resident that recently committed suicide. Jing Mai is another resident that committed suicide a year or two ago. So definitely, there’s still a long way to go, and I think we can start by enforcing those rules, programs showing their residents that they care about them.
Kevin Pho: We’re speaking to Medha Venigalla. She’s a medical student. Today’s KevinMD article is “The cost of exhaustion: Resident fatigue is a public health emergency.” Medha, let’s end with some take-home messages that you want to leave with the KevinMD audience.
Medha Venigalla: Yeah, I guess I just want to say that fatigue in residency is not just a resident issue. It’s a public health emergency. So the health care system at large needs to take care of our residents so that our residents can take care of their patients and improve outcomes for the patient population as a whole. So definitely, that’s something that we need to take action about, and I think that comes with shifting the culture within the field, as it is right now, to a culture that values the mental health and wellness of physicians, so they in turn can be better doctors for their patients.
Kevin Pho: Medha, thank you so much for sharing your perspective and insight, and thanks again for coming on the show.
Medha Venigalla: Thank you so much for having me.
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